注册护士上诉撰写员 – 家庭健康和临终关怀RAC
RN Appeals Writer – RAC for Home Health and Hospice
概述
对患者医疗记录中的临床信息进行详细审查、分析和提取，并起草有效的叙述内容，用于医疗保险和医疗补助上诉文件和简报，以支持所有政府上诉流程层级的被拒案件；保持对医疗编码、联邦和州医院利用审查（"UR"）法规以及医疗保险关于医疗必要性、住院、门诊和观察的相关指南的最新知识库；协助高级总监进行行政法官（"ALJ"）受益人听证会的研究和准备；可能在ALJ听证会上作为专家证人作证；与内部和外部法律资源合作，以应对直接影响RAC流程的流程或指南变化，从而实现最佳结果。
职责
对患者医疗记录中的临床信息进行详细审查、分析和提取，并起草有效的叙述内容，用于医疗保险和医疗补助上诉文件和简报，以支持所有政府上诉流程层级的被拒案件；保持对医疗编码、联邦和州医院利用审查（"UR"）法规以及医疗保险关于医疗必要性、住院、门诊和观察的相关指南的最新知识库；协助高级总监进行行政法官（"ALJ"）受益人听证会的研究和准备；可能在ALJ听证会上作为专家证人作证；与内部和外部法律资源合作，以应对直接影响RAC流程的流程或指南变化，从而实现最佳结果。
资格要求
教育
· 必须毕业于经认证的护理学院
工作经验
· 在使用电子病历的医疗保健环境中或使用InterQual或Milliman进行急性医院利用审查的临床经验，7年 Required
- 具有医疗记录审计经验，涉及医疗必要性索赔 Required
- 具有SCM / Quest、STAR、EPIC、Client Tracking和I-Suites等临床软件经验者优先
执照和认证
· 必须持有佐治亚州注册护士执照或NLC/eNLC多州执照 Required
- IQCI认证优先
业务单元：公司名称
Piedmont Healthcare Corporate
最初发布于Himalayas
查看英文原文
Overview
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.Responsibilities
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.Qualifications
Education· Graduate from an accredited School of Nursing Required
Work Experience
· 7 years of clinical experience in a healthcare setting using electronic medical records or acute hospital utilization review using InterQual or Milliman Required
- Previous experience with medical record auditing with medical necessity claims Required
- Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites is Preferred
Licenses and Certifications
· Current License in the State of Georgia as a Registered Nurse or NLC/eNLC Multistate License Required
- IQCI Certification Preferred
Business Unit : Company Name
Piedmont Healthcare CorporateOriginally posted on Himalayas